Medical Debt and Deferred Care for Physical Health, Mental Health, and Dental Needs Among U.S. Adults

Background

Medical debt burdens an estimated 20 million Americans and may contribute to unmet needs for healthcare.

Objective

To examine if medical, mental health, or dental needs are differentially sensitive to medical debt and if this varies by type of health insurance.

Design

Cross-sectional, nationally representative survey.

Participants

U.S. adult participants in the 2023 National Health Interview Survey.

Main Measures

Self-reported medical financial hardship (“medical debt”) and probability of deferred care in the past year for (a) medical, (b) mental health, and (c) dental needs, among adults with medical debt, compared to adults without medical debt.

Key Results

The overall prevalence of past-year medical debt was 10.7% [95% CI: 10.3, 11.2] and was high across all insurance market segments: 19.5% [17.5, 21.8] among uninsured adults, 12.6% [11.3, 14.1] among adults with Medicaid, 9.3% [8.8, 9.9] among adults with commercial insurance, and 8.1% [7.2, 9.2] among adults with Medicare. Medical debt was associated with a 24.6 [22.4, 26.8] percentage point (pp) increase in the probability of deferred dental care, 17.6 pp [15.9, 19.4] increase in the probability of deferred medical care, and 9.3 pp [7.9, 10.7] increase in the probability of deferred mental healthcare. Associations were largely consistent by health insurance category, although the association between medical debt and deferred medical care was significantly higher (P = 0.008) among uninsured adults (32.5 pp [25.6, 39.4]) than adults covered by commercial insurance (16.9 [14.7, 19.1]).

Conclusions

Medical debt was consistently associated with deferred care, with dental care most commonly deferred, followed by medical care and then mental healthcare. This association remained mostly consistent across all types of health insurance. Policy interventions that aim to address financial barriers to care and the accompanying burden of medical debt may mitigate the health and economic consequences of delayed and forgone care.